Dental and medical practitioners' perception of community water fluoridation as a caries preventive measure.

AIM: To evaluate and compare the perceptions and concerns of dental and medical practitioners towards water fluoridation as a caries preventive measure. METHODS: A self-administered questionnaire comprising 21 questions was designed and validated to assess general knowledge and concerns of fluoride and community water fluoridation (CWF) as a dental caries preventive measure. The questions examined participant's perception regarding effectiveness, advantages, adverse effects, cost-benefit, and concerns pertinent to CWF. Dentists, general physicians and paediatricians were randomly recruited from public medical/dental centres, university clinics, and the private sector to complete the questionnaire. RESULTS: A total of 474 participants (74% response rate) completed the questionnaire (294 dentists and 180 medical practitioners). About 86% of the dentists and 78% of the medical practitioners agreed that CWF has a role in caries prevention. However, only a few of those would advise their patients to drink fluoridated water. There were some concerns about CWF, and the main concern in both groups was dental fluorosis. The level of awareness regarding CWF status in Kuwait amongst the two groups was low. However, the majority in both groups (77%) believed that the water supply should be optimally fluoridated. CONCLUSION: Dental and medical health care professionals agreed that water fluoridation can benefit the oral health of the individuals in the community, however, general knowledge about fluoride benefits, safety, risks and status of public water fluoridation was low.

Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study.

AIM: To prospectively investigate the clinical and radiographic success rates of pulpotomy in permanent molars with clinical signs and symptoms suggestive of irreversible pulpitis using mineral trioxide aggregate (MTA) as a pulp dressing agent. METHODOLOGY: Sixteen patients with 23 restorable permanent molars exhibiting signs and symptoms indicative of irreversible pulpitis were enrolled. A standardized operative procedure was followed for all participants. All teeth were isolated with a dental dam and caries was removed, and then, pulpotomy performed with a sterile round and/or flame shape diamond burs. Haemostasis was achieved with 5% sodium hypochlorite (NaOCl). A mixture of MTA was placed against the wound, and a moistened cotton pellet was placed over the MTA. Teeth were temporized with a glass-ionomer restoration. Three to ten days later, the interim restoration was removed and setting of MTA was evaluated. Teeth were restored with stainless steel crowns. Follow-up evaluations were scheduled at 3, 6, 12 months and annually thereafter. Descriptive statistics were used to assess outcomes. RESULTS: The age of patients at time of pulpotomy ranged between 7.6 and 13.6 years (mean = 10.7± 1.7 yrs). The majority of teeth (91%) had clinical signs and symptoms consistent with a diagnosis of symptomatic irreversible pulpitis and symptomatic apical periodontitis (78%). The follow-up examination period ranged from 18.9 to 73.6 months. Clinically and radiographically, all pulpotomies were considered successful at the end of the follow-up period. Radiographically, a hard tissue barrier was noticed in 13 (57%) teeth. CONCLUSION: In children, MTA was associated with high clinical and radiographic success as a pulpotomy agent in permanent teeth with clinical signs and symptoms suggestive of irreversible pulpitis.

Clinical success and longevity of band and loop compared to crown and loop space maintainers.

AIM: To prospectively evaluate the success and survival rates of band and loop (B&L) compared to crown and loop (C&L) space maintainers. METHODS: Thirty-six children were divided into two groups (18 B&Ls and 18 C&Ls) matched for gender, age and the extracted tooth. For the study group, all clinical procedures were performed by the same paediatric dentist. Regular follow-up appointments were scheduled at 4-6 months. Comparisons in survival time and variables which might have affected the mean survival time were tested using Log rank and Chi-square tests. RESULTS: A total of 16 girls and 20 boys (3.4-6.3 years old) were included. The overall failure rate was 53 %. For B&Ls, the failure rate was 83 % compared to 22 % for C&Ls. The main reason for failure of B&Ls was decementation (87 %), while for C&Ls, it was solder breakage (75 %). The mean survival time for B&Ls was 18.8 months, and for C&L, it was 40.4 months (p < 0.001). CONCLUSIONS: The failure rate and mean survival time for C&Ls were clinically and statistically significantly better than those for B&Ls. Depending on the clinical presentation of the abutment tooth and the intended life expectancy of the space maintainer among other factors, it is recommended that, where a space maintainer is indicated in the primary dentition, preference is given to C&L over B&L space maintainers.

The Effect of Combining Radiographs and DIAGNOdent With Visual Examination on Detection and Treatment Decisions of Noncavitated Occluso-dentinal Caries.

The aim of this laboratory study was to evaluate the effectiveness of incorporating radiographic examination and DIAGNOdent with visual examination for the detection and treatment of noncavitated occluso-dentinal caries. Four examiners examined the occlusal surfaces of 160 extracted posterior teeth. Teeth were examined three times with a one-month interval in between. The first examination was visual (V), the second examination was visual with radiograph (VR), and the third examination was visual with radiograph and DIAGNOdent (VRD). Examiners were asked to detect the presence of caries (if any) and identify the extent of caries (if present; ie, enamel or dentin). The examiners were also asked to choose a treatment for each tooth. The examined teeth were later sectioned, and the presence of caries was charted as 0 = no caries, 1 = caries confined to enamel, 2 = caries in the outer dentin, and 3 = caries in the inner dentin. Sensitivity, specificity, area under the curve (Az values), rank correlation coefficient, interexaminer reproducibility, and McNemar χ(2) tests were calculated. VR had statistically higher specificity and lower sensitivity than V and VRD. The means of Az values ranged from 0.58 to 0.63, with no statistical difference between the three examinations (p>0.05). The means of the rank correlation coefficients with histology for detection of dentinal caries were 0.48, 0.23, and 0.44 using V, VR, and VRD, respectively. Interexaminer reproducibility was best for V alone. The percentages of teeth indicated for restorative treatment were 31%, 33%, and 41% using V, VR, and VRD, respectively. The percentages of teeth correctly treated according to histology were 69.4%, 70.0%, and 67.5% using V, VR, and VRD, respectively. There was no difference in the accuracy of treatment decisions between the three examination points (p>0.05). The addition of radiographs and DIAGNOdent to visual examination did not have a significant effect on the improvement of the detection or treatment decisions of examiners of noncavitated occluso-dentinal carious lesions.

Longevity of band and loop space maintainers using glass ionomer cement: a prospective study.

AIM: This was to prospectively investigate the success and median survival rate of band and loop space maintainers using glass ionomer luting cement for attachment. METHODS: A total of 40 children (22 females and 18 males) between the ages of 3.4 and 7.3 years participated in the study. Each patient received only one band and loop space maintainer. For each child, the same paediatric dentist carried out all diagnosis, band selection, and impression taking and appliance cementation. The same dental technician fabricated all appliances. The luting cement used was Ketac-Cem-Maxicap. Regular follow up appointments were scheduled at 4-6 months intervals. Variables, which might have affected the median survival time for the appliances were tested using Log-Rank and Chi-square tests. RESULTS: 40% of the band and loop space maintainers were successful and 57.5% failed during the study period (40 months). The most common cause of failure was decementation (82% of all failed cases). The overall median survival time was 19.9 months. Appliances fitted in the maxillary and mandibular left side of the mouth showed a statistically higher survival rate than those fitted in the right side (maxillary left quadrant = 35 months, mandibular left quadrant = 28 months, maxillary right quadrant = 14 months, mandibular right quadrant = 16 months) (p<0.008). CONCLUSIONS: Although the overall median survival time was clinically acceptable (19.9 months), the failure rate of the band and loop space maintainers in general was high (57.5%). The main reason for failure was decementation of the band. Further studies are required to compare glass ionomer cements with more recent resin modified luting cements.

Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries.

AIM: To prospectively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide (CH) and mineral trioxide aggregates (MTA) as pulp dressing agents. METHODS: Restorable permanent first molars (64) with carious pulp exposures were randomly assigned to two groups; CH and MTA. A standardized operative procedure was followed in both groups. Following isolation and caries removal, the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2-4 mm. Bleeding was controlled and pulp dressed with either a paste of non-setting Ca(OH)2 followed by a setting layer of Ca(OH)2, or with grey MTA. The dressing materials in both groups were then covered with a layer of light cured glass ionomer cement. The teeth were either restored using amalgam, or where grossly carious with preformed metal crowns. Patients were scheduled for follow-up at 3, 6, 12 months and annually thereafter. RESULTS: There were 34 patients (17 males and 17 females) with 51 teeth available for evaluation. The age of patients at the time of restoration ranged between 6.8 to 13.3 years (mean of 10.3 +/- 1.8 years). The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 +/- 4.4 months. There was no statistically significant difference in the success rate of teeth treated with CH (91%) in comparison to teeth treated with MTA (93%). Radiographically, a hard tissue barrier under CH was noticed in 12 (55%) teeth compared with 18 (64%) teeth under MTA (p=0.4). CONCLUSIONS: MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious exposures.

Restorative treatment decisions for deep proximal carious lesions in primary molars.

AIM: To assess clinicians' individual variables that might influence decision-making for the restoration of deep proximal carious lesions in primary molars. METHODS: A pre-coded questionnaire that sought participants' treatment choices for a deeply carious second mandibular primary molar, as depicted in a simulated periapical radiograph, along with a specific clinical scenario, was distributed among a random sample of 157 dentists and 15 paediatric dentists. Participants were asked to answer questions. After combining the pulpotomy and pulpectomy treatment choices under a 'pulp therapy' category, a binary dependent variable was constructed. Logistic regression of the ratio of the participants who would restore the questioned tooth by a method in question, was run. RESULTS: A total of 155 dentists (116 males and 39 females) completed the survey, giving a response rate of 90%. Of these 53% of dentists recommended pulpotomy followed by definitive restoration and 39% recommended removal of caries and restoration without pulp therapy. In the logistic regression model, males and graduates of English language undergraduate dental programs had higher probabilities of restoring without prior pulp therapy (p<0.03 and p<0.02, respectively). Compared with graduates of Asian programs, dentists who graduated from Eastern Europe and the Middle East, showed lower likelihoods of restoring the tooth without prior pulp therapy (p<0.01 and p<0.004, respectively). Dentists who treated an average of 6-16 child patients during a week had a lower probability of restoring the tooth without prior pulp therapy than those who were not currently involved in treating children (p<0.01). No other measured variables were associated with participant's treatment choices. CONCLUSIONS: The lack of agreement among dentists regarding their optimal treatment recommendations for deep proximal carious lesions appears to be due mainly to inter-individual, educational, training and practice characteristic factors.

Mixed dentition space analysis in a Jordanian population: comparison of two methods.

AIMS: To test the reliability of the Moyers charts and the Tanaka and Johnston equations in Jordanians and to derive coefficients of correlation between the combined mesiodistal widths of the four permanent mandibular incisors and the combined widths of the canine and premolars of the maxillary and mandibular quadrants. METHODS: The dental models of the dentition of 130 male and 96 female Jordanian subjects (age range is 14-16 years) with complete permanent dentition were randomly selected. The mesiodistal width of the four permanent mandibular incisors, maxillary and mandibular canines, and premolar teeth were measured using a vernier gauge caliper to the nearest 0.1 mm. The actual teeth measurements were then compared with the predicted values derived from the Tanaka and Johnston equations and Moyers probability tables. Correlation and linear regression analyses were performed between the predicted and actual tooth size for Jordanian children and standard regression equations were developed. RESULTS: Except for the maxillary arch in male subjects, Tanaka and Johnston regression equations underestimated the mesiodistal widths of permanent canines and premolars. On the other hand, there were no statistically significant differences between actual mesiodistal widths of canines and premolars and the predicted widths from Moyers charts at the 65% and 75% level for the lower and upper arches in male subjects and at the 85% level for the upper and lower arches in female subjects. For the newly developed regression equations, the correlation coefficients between the sum of the mandibular four incisors and the sum of the canine and premolars were 0.60 (for lower) and 0.51 (for upper) in male subjects and 0.59 and 0.64, respectively, in female subjects. CONCLUSIONS: (1) Tanaka and Johnston prediction method was not accurate when applied to a Jordanian population. (2) Moyers method for prediction can be used for Jordanian children at different probability levels for male and female subjects.

Dental arch morphological and dimensional characteristics in Jordanian children and young adults with beta-thalassaemia major.

OBJECTIVE: The aim of this study was to examine the arch dimensions of Jordanian patients with beta-thalassaemia major in comparison with an unaffected control group. METHODS: The sample consisted of 24 patients who suffered from beta-thalassaemia major (mean age = 13.9 +/- 3.1 years) and an unaffected control group (mean age = 13.5 +/- 2.9 years) matched for dental age, sex, and incisor and molar relationships. The unaffected control group was randomly selected from four public schools in the Governate of Irbid-Jordan. Alginate impressions were taken of the maxillary and mandibular dental arches of all participants. All measurements of the arch dimensions were made on the casts using an electronic digital sliding calliper. RESULTS: In the mandibular arch, when compared with the patients with thalassaemia, the unaffected control group subjects showed a (statistically) significantly larger incisor width, larger arch depth, and larger left and right anterior arch lengths (1.18, 2.58, and 1.85 and 1.12 mm, respectively). In the maxillary arch, there was a statistically significant difference in the mean incisor width (+/- 2.16 mm), arch depth (+/- 3.14 mm), inter-molar width (+/- 1.21 mm) and in the left anterior arch length (+/- 1.97 mm). The canine widths, premolar widths, left and right posterior arch length, and curve of Spee of both arches showed no statistically significant differences between the two groups. CONCLUSION: When compared to unaffected subjects, patients with beta-thalassaemia major exhibited: a narrower maxilla; a shorter maxilla and mandible; and smaller incisor widths for the maxillary and mandibular arches.

Occlusion and tooth/arch dimensions in the primary dentition of preschool Jordanian children.

OBJECTIVES: To assess tooth and arch dimensions, occlusal relationships and the presence of spacing or crowding in primary dentition of Jordanian children. STUDY DESIGN: A list of 10 kindergartens was randomly selected in the governate of Irbid, Jordan. A total of 1048 children (2.5-6 years old) with complete primary dentitions were examined for occlusal relationships in three planes, and the presence of spacing or crowding. Of those, study casts were taken for 87 randomly selected 4-5-year-old children (39 girls, 48 boys). Measurements of tooth and arch dimensions were made using electronic digital sliding callipers. RESULTS: In general, males had larger mesiodistal tooth width and larger arch dimensions. Bilateral mesial step molar relationship was found in 47.7% of children followed by bilateral flush terminal molar relationship in 37% and bilateral distal step in 3.7%. Asymmetric right/left molar relationship was found in 11.6% of children examined. Class I canine relationship was found in 57% of children, followed by Class II canines in 29% and Class III canines in 3.7%. Fifty per cent of children examined had Class I incisors, 24.7% had Class II Division 1, 13.5% had Class II Division 2 and 11.8% showed reversed overjet. Ideal overbite was seen in 44.3% of children, reduced overbite in 21.8%, increased overbite in 28.2% and 5.7% had anterior openbite. Buccal crossbite was seen in 7% of the sample. Generalized spacing was found in 61.8% and 61.1% of children in the upper and lower arches, respectively. Anthropoid spaces were found in 70% of the upper arches and in 51% of the lower arches. CONCLUSIONS: Males had larger tooth/arch dimension than that of females in the primary dentition stage. Mesial step molar relationship was found in 47.7% of the subjects followed by flush terminal molar relationship in 37%. The majority of children examined had spaced primary dentition.

Dental discoloration: an overview.

UNLABELLED: Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management. CLINICAL SIGNIFICANCE: This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.

The use of space maintainers at a UK pediatric dentistry department.

Space maintainers have been in use in pediatric dentistry for many years. The use of these appliances, however, in terms of indications, contraindications, design, and construction, has gained little attention from researchers. It is clearly essential that when space maintainers are fitted, it is the result of careful planning and appropriate prescriptions.

The longevity of space maintainers: a retrospective study.

METHODS: This retrospective study investigated the longevity of 301 space maintainers fitted in 141 patients aged 3.4-22.1 years in the Department of Pediatric Dentistry at Leeds Dental Institute between 1991 and 1995. RESULTS: Failure occurred in 190 space maintainers (63%), of which 36% were due to cement loss, 24% breakage, 10% design problems, and 9% were lost. Using the life table method, the median survival time (MST) for space maintainers was found to be 7 months. Band and loop (B&L) appliances had the highest MST of 13 months, while the lower lingual holding arch (LLHA) had the lowest of 4 months. Unilateral space maintainers survived longer than bilateral space maintainers (MST of 13 months vs. 5 months). Left B&Ls had a MST of 16 months, compared to only 4 months for right B&Ls, Gender, age, arch in which the appliance was placed, the operator planning it, fixed vs. removable, and adequacy of pretreatment assessment did not have a significant effect on survival time.